State Health Insurance Assistance Programs Underused Among Medicare Beneficiaries Making Enrollment Decisions

Open Enrollment Period Ending with Little Use of Decision Supports

As this year’s Medicare Open Enrollment Period draws to a close, the Commonwealth Fund released two analyses – one examining how often and why beneficiaries make coverage changes and one highlighting the often underutilized decision-making support and resources available through the State Health Insurance Assistance Program (SHIP) network. Together, these articles highlight the importance of informed coverage choices and point to the need for more and better beneficiary tools and outreach.

An Overabundance of Plan Options

Just because there are options available doesn’t mean that people evaluate or change plans from year to year. 

Noting that the decisions facing beneficiaries can be challenging, the first article explains the coverage choices available to people with Medicare–both deciding whether to access coverage through Original Medicare or a Medicare Advantage (MA) plan and then choosing among different MA and Part D plans. For 2025, the average beneficiary can choose among 34 MA plans and 15 Part D plans – all with different costs and rules. But just because there are options available doesn’t mean that people evaluate or change plans from year to year.

Indeed, the data from the Commonwealth Fund 2024 Value of Medicare Survey show that in the past two years, only 15% of beneficiaries switched their coverage. This may suggest that people are satisfied with their coverage. It could also reflect inertia, lack of usable information about other options, or decision overwhelm. Callers to Medicare Rights’ helpline have reported all of these factors when seeking our assistance after being surprised by how their plans changed from one year to the next in January, or when they learn of other options that can or could have decreased their costs or reduced other burdens.

Help Is Available but May Not Always Be Unbiased

There are an array of resources available to help people navigate Medicare coverage decisions. Medicare Rights’ helpline connects with many callers during Medicare Open Enrollment to assist people in evaluating their coverage options to select the best plan for their health and financial needs. We are proud to do this important work and to develop policy recommendations to improve the plan choice process and tools built on our hands-on experiences.

But not every beneficiary reaches out to us. Some who shop around or change plans report going it alone, often using online tools and resources or plan-provided materials to make enrollment decisions. Others may get advice or assistance from an insurance agent or broker. This can come with unique challenges, including broker and agent financial incentives that may not align with the beneficiary’s best interest. As the Commonwealth Fund cautions, beneficiaries must “be alert to the possibility that their insurance broker or agent is making a recommendation driven by their own financial interest and in response to commission incentives.”

Like Medicare Rights, State Health Insurance Assistance Programs (SHIPs) can also provide clear and impartial help.

SHIPs Offer Free, Unbiased Support but Known to Few

The Administration for Community Living administers SHIPs and provides grants to states, which, in turn, fund local organizations, including Area Agencies on Aging (AAAs), to provide a range of services to Medicare beneficiaries, including assistance with Medicare coverage decisions from paid and volunteer counselors. This free, well-trained, and objective resource can help people identify the best coverage option for their unique situation, increasing their access to care and saving them money. However, the Commonwealth Fund found that only 1 in 20 beneficiaries reported using a SHIP to help them make coverage choices. According to interviews with SHIP staff, most beneficiaries learned about their program via word of mouth or referrals from government agencies.

To increase the SHIPs’ reach and impact, the authors see promise in new Medicare regulations that require agents and brokers, as well as other third-party marketing organizations advertising Medicare products, to tell beneficiaries about the free resources available through Medicare.gov, 1-800-MEDICARE and SHIPs. They also recommend increasing nationwide naming consistency–many states use specific names for their SHIP–and increasing national communications strategies. The Medicare Rights Center supports stronger consumer protections, more robust decision-making tools, and greater SHIP capacity.

Additional Resources

To find your local SHIP, visit www.shiphelp.org.

Call 1-800-MEDICARE (1-800-633-4227) for 24-hour support.